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Distinction Between Cerebral Apoplexy andDistinction Between
Cerebral Apoplexy and
PostPost--traumatic Intracerebral Hemorrhage:traumatic
Intracerebral Hemorrhage:a) In traumatic intracerebral hemorrhage
the
interval between the injury and onset of strokeis usually a week
or less.
b) In traumatic intracerebral hemorrhage, the injuryto the head
must be sustained when the head isin motion and the hemorrhage is
the result ofthe coup-countre-coup mechanism.
c) The location of traumatic intracerebral
hemorrhage is in the central white matter of thefrontal or
temporo-occipital region. Cerebralapoplexy is usually at the basal
ganglia, a veryuncommon site of traumatic
intracerebralhemorrhage.
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d) History of hypertension prior to the stroke
and evidence of degenerative disease are
present.
BRAIN:
A. Laceration of the Brain
1. Direct or Coup Laceration2. Countre-coup Laceration
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yWithin 3 hours
y 6-12 hours
y 12-24 hoursy 1-2 weeks
y 1 month
HistoHisto--pathological changes followingpathological changes
following
contusion and laceration of the cerebralcontusion and laceration
of the cerebral
Cortex:Cortex:
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Edemas of the Brain:Edemas of the Brain:
Localized Edema
Generalized Edema
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Concussion of the Brain:Concussion of the Brain:
Is a transitory period of unconsciousness
resulting from a blow on the head, unrelated to
any injury to the brain which is apparent to the
unaided eye. Symptoms vary upon the degree of injury.
In cases of recovery, there is usually a
retrograde amnesia of the accident and even
events before and after it.
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Compression of the BrainCompression of the Brain
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Face:Face:
A. Eye
Contusion of the soft tissue about the eyes is sub-
conjunctival.
Hemmorhage is frequently observed in a first blow. Fracture of
the base of the anterior cranial fossa
may also produce contusion of the eyelids.
Eye may be lacerated by a blunt weapon or by a
piece of stone.
Penetrating wounds due to sharp instruments or
bullets may cause meningitis or total blindness.
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B. Nose
x Fracture of the nasal bone is a common
sequelae of first blows, and may cause
severe epistaxis and facial deformity.x Injuries of the nose are
usually
dangerous to life on account of the
extension of infection to the brain.
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C. Ear
x A blow on the ear may produce arupture of the tympanic
membrane
leading to permanent or temporarydeafness.
x Hemorrhage coming from the ear maysuggest fracture of the base
of themiddle cranial fossa.
x The trauma in the ear may cause septicinfection amd may extend
to the brainand causes death.
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D. Mouth
x Contusion, laceration and swelling of thelips are usually
observed in a first blow,kick or bite.
x Fracture of the lower jaw is usually dueto direct
violence.
x Occasionally a gun shot wound in
suicidal case is found inside the mouthand investigators are
usually at loss inthe examination and location of thewound of
entrance.
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NeckNeck
Abrasions of the neck may be present in cases
of manual strangulation.
Ligature marks are present in death by hanging.
Suicidal cut-throat wounds are usually diagonalwhile homicidal
wounds are usually horizontal.
Asphyxia, pneumonia, hemorrhage and shock
are the common causes of death from neck
injuries.
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Vertebral Column and Spinal Cord:Vertebral Column and Spinal
Cord:
a. Fracture of the vertebrae
x Injury of the cord due to fracture of the upperfour cervical
vertebrae causes paralysis of thephrenic nerve, while those due to
fractures ofthe 5th cervical vertebra to the first dorsal
vertebrae may cause paralysis of all theextremities.
The causes of the fracture of the spine may be:
1. DirectViolence
2. IndirectViolence
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b. Concussion of the Spine
x May occur even without visible signs of
external injuries.
x The usual complaints are headache,restlessness, pain and
tenderness over
the spine, loss of sexual power, irritability
of the bladder, inability to walk, weakness
of the limbs, and derangement of thespecial senses.
